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HomeMy WebLinkAboutUpdated Building Permit All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED / Date: ` ZZ- �� 2I Permit Number. / V (— ���� Building Permit Application Planning and Development Services Building and Code Regulation Division Commercial Residential 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 PERMIT APPLICATION FOR: �, S r�-� PROPOSED IMPROVEMENT LOCATION: Address: C(q H0 S . DtCaw D Y ,'ule, -S te,50o 1 eqe t, C 4- '; of Ct 5 Property Tax ID#: 4 5 d 2 - S 0 Z - (j 1 - Q Q Lot No. Site Plan Name: oc [Cc./ Block No. Project Name: DETAILED DESCRIPTION OF WORK: Lit I New Electrical Meter Second Electrical Meter CONSTRUCTION INFORMATION: Additional work to be performed under this permit—check all that apply: _Mechanical _Gas Tank _Gas Piping —Shutters _vtlindows/Doors Pond —Electric _Plumbing _Sprinklers _Generator Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $ Utilities: _Sewer _Septic Building Height: OWNER/LESSEE: CONTRACTOR: Name Name: F( r N as J n L ;b jrgiros Address: C Company: Co,��(l t t J�t {;ow b y 601 ely City: �iwS'Ctii State: Address: Cc &V Zip Code: Fax: City: UJeS+ P aR,.rt C3 C aC H State: FL Phone No. Zip Code: 13 LI Oq Fax: E-Mail: Phone No Fill in fee simple Title Holder on next page(if different E-Mail 15 yq�p0,C O from the Owner listed above) State or County License_ t S J_ 01 3 y If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. If value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGNER/ENGINEER: —Not Applicable MORTGAGE COMPANY: _Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable Name: Name: Address: Address: City: City: Zip: Phone: Zip: Phone: OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated. I certify that no work or installation has commenced prior to the issuance of a permit. St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply. In consideration of the granting of this requested permit, I do hereby agree that I will,in all respects,perform the work in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments. The following building permit applications are exempt from undergoing a full concurrency review:room additions, accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in paying twice for improvements to your property. A Notice of Commencement must be recorded in the public records of St. Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult with lender or an attorney before commencin work or rec ---cement. Signature of Owner/Le see/C tractor as Agent for Owner Signat of Cont actor/License Holder STATE OF FLORIDA ' STATE OF FL RDA COUNTY OF �}. L l>tC'e- COUNTY OF MP4T Sw'w to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of Physical Presence or Online Notarization Physical Presence or Online Notarization this day of 202t by thi day of 202f by a M1 JQ Li✓ m S Name of person m king statement. Name of person making statement. Personally Known OR Produced Identification Personally Known Y—OR Produced Identification Type of Identification Type of dentification Produced - 5"] '5�I )—O Produ e RO VSKY r f i 40 Signature Na ary Public State of Florida ) (Si ature of Notary Publl lorid�"jmi.Ex s 231,20 My Comm.Ex res Jul 8,2022 e t u at on a!Notary Assn. Commission No. 0 ' (Seal) Commission N REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. PLLM(c of F0,00 Ezp ns 0�0 02a 912671 O�F� `l` L1 UCLI-- Planning and Development Services Building and Code Regulations 2300 Virginia Avenue V * c1 Fort Pierce, FL 34982-5652 NOTICE TO BUILDING OFFICIAL OF SPECIAL INSPECTOR I (we) have been retained by �0��yL �dG Owner, to perform special inspector services in accordance with the Florida Statutes 471 & 553 and the Florida Building Code—6th Edition 2017. Project Name: 0( e u N u Co n c If (4 t fi�cu f� Permit# I F7 I d 7 t L Address: q c 0 5 ©(Po o D r F City "$ e n e a 13r4 zip IL �l S NOTE: ONLY THE MARKED BOXES APPLY SPECIAL INSPECTOR FOR PILINGS SPECIAL INSPECTOR FOR SOIL COMPACTION AND FOUNDATIONS SPECIAL INSPECTOR FOR SHORING SPECIAL INSPECTOR FOR REINFORCING MASONRY AND ALL CONCRETE ELEMENTS SPECIAL INSPECTOR FOR POST-TENSION CABLES AND ACCESSORIES SPECIAL INSPECTOR FOR STEEL AND/OR WELDED CONNECTIONS SPECIAL INSPECTOR FOR FLOOR AND ROOF TRUSSES SPECIAL INSPECTOR FOR PRECAST UNITS, TILT WALL,ATTACHMENTS& REBAR PLACEMENT SPECIAL INSPECTOR FOR CURTAIN WALL AND/OR STRUCTURAL GLAZING SPECIAL INSPECTOR FOR PLYWOOD DECK AND/OR METAL DECK AND ATTACHMENTS SPECIAL INSPECTOR FOR THE FOLLOWING (If not identified above): C C-nivreit 2-f51 oruflo &X *The following individual(s) employed by this firm are authorized representatives to perform inspections on the project named herein and are authorized by the signature and seal below 1. 2. 3. 4. a. Authorized Representatives of an Engineer or an Engineer performing threshold inspections shall conform to Rule 61G15-30.004 of the F.A.C. &FL Statute Section 553.79(5)(a),(b)and(c), Sections 110.7& 110.8 of the Florida Building Code(FBC) b. Special inspectors performing building department required inspections shall conform to the 6th Edition(2017) Florida Building Code,comply with Section 110.8, and be licensed under FS 468 Part XII. Permission to perform these inspections may only be performed under specific authorization of the Building Official C. The special inspector may not serve as a surrogate in carrying out the responsibilities of the building official,the architect,or the engineer of record d. A list of all individuals performing actual inspections with their qualifications, resumes and license information shall be furnished to the Building Department for approval with this document. Only persons listed on this document and authorized by the Building Official or his/her representative will be accepted I, (we) will notify the St. Lucie County Building Department of any changes regarding authorized personnel performing inspection services. I, (we) understand that a Special Inspection Log for each building must be displayed in a convenient location on the site for reference by the St. Lucie County Building Inspector. All Page 1 of 2 Special Inspector Form 2/17/2020 mandatory inspections, as required by the Florida Building Code, must be performed by the County. The St. Lucie County Building Inspector must be called for all mandatory inspections. Inspections performed by the Special Inspector hired by the Owner are in addition to the mandatory inspections performed by the Building Department. Upon completion of the work under each Building Permit, I (we) will submit to the St. Lucie County Building Inspector at the time of final inspection the completed inspection log form and a signed and sealed statement indicating that, to the best of my knowledge, belief and professional judgment, those portions of the project approved for special inspections and permits outlined above and are in substantial accordance with the approved plans. I (we) hereby certify that if shoring is needed to be installed on an emergency basis, it will be in compliance with the provisions of the Florida Building Code and in conformance with generally accepted enaineering standards. Engineer Printed Name: itenbach PE — John D. Bre , 4853 SE Pilot Way Engineer Signature: Stuart, Florida 34997 Company Name: Breitenbach Engineering Address: 4853 SE Pilot Way Stuart, Florida 34997 City: ie (� - PE #o<a 7"70 SI # 'L Signed & Sealed: 6REl •. ENS`' No. 6�77 o s �1 /#IIIitlit'O" Owner/Agent Printed Name: Owner/Agent Signature: For St Lucie County Office Use Only Date document received: / / By: Y Permit# Authorization: Date: Page 2 of 2 Special Inspector Form 2/17/2020